The leaders of the Michigan nonprofit charged with coordinating the online exchange of health records say they have made much faster progress than before by relying on Salesforce.com to provide a foundation of cloud software and servers.

"For us, the Force.com platform started one of fastest ways to get the health provider directory up and demonstrable," said Tim Pletcher, executive director of the Michigan Health Information Network Shared Services (MiHIN). "Once we did that, we realized this wasn't just the environment to get a fast prototype or demo working -- this was the environment to run it on."

MiHIN is part of the national push to create a system where doctors offices, hospitals, and other healthcare providers will be able to exchange digital records on patients through services known as health information exchanges (HIEs). MiHIN is the "state designated entity" charged with coordinating that activity at a state level, but it is not itself an HIE. While some other states are creating statewide HIEs, Michigan is instead pursuing a strategy that includes multiple HIEs -- regional, specialized, profit and nonprofit -- with MiHIN providing shared services that allow them to work together. In April, Blue Cross Blue Shield of Michigan signed on as a qualified data-sharing partner.

"We're after the Internet approach, where you have lots of standards and trust relationships," Pletcher said. Like the Internet, MiHIN is meant to be a "network of networks."

One of the key pieces MiHIN provides is a provider directory service, which the HIEs all feed into, providing the technical and addressing information required for routing data from one provider to another. In some cases, MiHIN also relays the data from one provider to another, but it does not act as a central repository of patient information.

A more advanced usage, which MiHIN is just starting to explore, is a distributed query capability, which would make it possible to pull together an individual patient's records from multiple healthcare facilities. In addition, MiHIN provides an alerting service, which could, for example, alert a doctor to the fact that his patient has just been discharged from the hospital and ought to be scheduled for a follow-up visit. MiHIN also supports routine reporting for public health purposes.

These challenges have little to do with sales force automation, which is where Salesforce.com got its start as one of the first cloud application providers to win the respect of large enterprises. Pletcher said MiHIN does take advantage of the Salesforce.com Sales Cloud applications -- although it is a nonprofit, it still has relationships to manage and services to market -- but at a deeper level the MiHIN online services themselves have been built on the Saleforce.com platform. Through Force.com, Salesforce.com allows developers to create their own custom applications, which can incorporate graphical user interface (GUI) and logical components from the vendor's software suite, or tap into its application programming interfaces (APIs) to simplify integration challenges.

"Those building blocks enable us to go fast and do things quickly," Pletcher said. "We can build on concepts like relationship management and take advantage of the APIs. And the whole GUI -- the bones of that are there and available for us to use."

In a sales and marketing context, Salesforce.com models relationships between buyer and seller organizations and people within those organizations, while distinguishing between "opportunities" (potential customers) and "accounts" (active customers). MiHIN found it could extend the underlying software objects to model the complex relationships between healthcare organizations and between organizations and physicians, he said. For example, physicians might work with multiple hospitals and through a private practice.

"All those building blocks are mature, commercial grade tools," Pletcher said, and that made it possible for MiHIN to build a high-quality product of its own. Without that head start, "I think it would have cost us a lot more," he said. What's more, today MiHIN would likely be a "really elegant reference implementation" of the relevant standards, rather than a production service, if his team had tried to create it from scratch, he said.

There still are not a lot of examples of other states putting a comparably functional service online, Pletcher said. Because of that, his organization is beginning to explore the possibility of offering the service beyond the bounds of Michigan for a fee, he said. "It would be a really cost-effective way of getting high reuse out of some systems we've developed here."

I did find that odd as well. Usually when talking about Cloud services, privacy and security are the biggest issues. I wonder what sort of security is offered by the Salesforce system. I cant imagine that it is anything petty though, as they are trusting it with a lot of patient health information and I'm pretty sure they have done their research.